Pregnancy

Pregnancy By Leslie Bebber & Marge Batterson

Clinical Seminar III Fall 2009

The Fun Begins • Divided into 3 trimesters • • Normal pregnancy is 40 weeks • • Premature birth is <37 weeks

First Trimester • Highly susceptible to injuries and malformations • Teratogenic effects from poor nutrition, infections and drugs • All organ systems formed • By 12 weeks fetus moves and swallows • Tooth buds develop between 5th and 6th week • Lips form during 4th to 7th week • Palate forms between 8th and 12th week • Cleft lip apparent by 8th week and cleft palate by 12th week

Second and Third Trimesters • • Organs are fully formed • • Growth and maturation continue • • Fetal weight changes from 1oz at 3months to an average of 7.5 lbs at birth

The Pregnant Patient • Have patient lie on left side with a rolled blanket or pillow under the right hip • Increase frequency of recall to 3months • Spend extra time on home care instructions • Ultasonics are not contraindicated • Recommend a daily fluoride program • Smoking cessation program if

Health and Pregnancy • Proteins for general tissue construction • • Minerals, especially calcium and phosphorus for bone and tooth mineralization; iron for blood corpuscles • • Vitamins, especially vitamin D for calcium metabolism, folate to prevent birth defects and vitamin A to prevent preterm birth.

Perio and Pregnancy

• Accounts for more than 18% of all preterm births

• • This is more significant than cigarette smoking or alcohol use

• • Lipopolysaccharides (endotoxins) from pathogenic periodontal plaque bacteria cross the placental barrier and stimulate the inflammatory response

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“Pregnancy Tumor” Pyrogenic granuloma Smooth or lobulated Pedunculated Ranges from pink to red to purple Highly vascular 75% occur on the gingiva, however it is important to note that they may occur on the tongue, lips, and buccal mucosa • Begin in 1st trimester up to the 7th month • Related to increased levels of estrogen and progesterone • Most resolve after parturition • • • • • •

“Mask of Pregnancy” • Acquired, symmetrical hyperpigmentation of the sun-exposed skin of the face and neck • Unknown cause • More common is Asian and Hispanic women • Exposure to exogenous estrogen and progesterone from oral contraceptives or hormone replacement therapy may also cause melasma • Difficult to treat

Tooth Mobility • • • Tooth mobility may be associated with pregnancy • • Last few weeks before delivery • • Increased hydration of connective tissues • • With or without periodontal disease

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• Avoid if possible • • Additional lead apron for the back to prevent secondary radiation from reaching the abdomen

Local Anesthetics • Medical consult recommended • • Local anesthetic and vasoconstrictors are not teratogens 

• Use in moderation

Nitrous Oxide Sedation • Nitrous oxide is contraindicated during the first trimester • • • If used in the second or trimester it must be minimized to 30 min with 50% oxygen •

Other Considerations • • • • • • • •

Frequent urination Backache Faintness and dizziness Adverse reactions to strong smells and flavors Exaggerated reactions to odors and flavors of medicaments Nausea and vomiting Gagging Unusual food cravings (sweets)

Dental Care • Postpone elective treatment until the second trimester (NOT HYGIENE!!!!) • Increase frequency of recare • No temporary restorations • Short mid-morning appointments • Extra time spent on proper home care • IMPORTANT don’t forget the baby!!

Brush Your Teeth!!!